title: Adrenomedullin refines mortality prediction by the BODE index in COPD: the "BODE-A" index.
abstract: The BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity) index is well-validated for mortality prediction in chronic obstructive pulmonary disease (COPD). Concentrations of plasma pro-adrenomedullin, a surrogate for mature adrenomedullin, independently predicted 2-year mortality among inpatients with COPD exacerbation. We compared accuracy of initial pro-adrenomedullin level, BODE and BODE components, alone or combined, in predicting 1-year or 2-year all-cause mortality in a multicentre, multinational observational cohort with stable, moderate to very severe COPD. Pro-adrenomedullin was significantly associated (p<0.001) with 1-year mortality (4.7%) and 2-year mortality (7.8%) and comparably predictive to BODE regarding both (C statistics 0.691 versus 0.745 and 0.635 versus 0.679, respectively). Relative to using BODE alone, adding pro-adrenomedullin significantly improved 1-year and 2-year mortality prognostication (C statistics 0.750 and 0.818, respectively; both p<0.001). Pro-adrenomedullin plus BOD was more predictive than the original BODE including 6-min walk distance. In multivariable analysis, pro-adrenomedullin (likelihood ratio Chi-squared 13.0, p<0.001), body mass index (8.5, p=0.004) and 6-min walk distance (7.5, p=0.006) independently foretold 2-year survival, but modified Medical Research Council dyspnoea score (2.2, p=0.14) and forced expiratory volume in 1 s % predicted (0.3, p=0.60) did not. Pro-adrenomedullin plus BODE better predicts mortality in COPD patients than does BODE alone; pro-adrenomedullin may substitute for 6-min walk distance in BODE when 6-min walk testing is unavailable.
authors.forename: Daiana
authors.initials: D
authors.lastname: Stolz
authors.forename: Kostantinos
authors.initials: K
authors.lastname: Kostikas
authors.forename: Francesco
authors.initials: F
authors.lastname: Blasi
authors.forename: Wim
authors.initials: W
authors.lastname: Boersma
authors.forename: Branislava
authors.initials: B
authors.lastname: Milenkovic
authors.forename: Alicia
authors.initials: A
authors.lastname: Lacoma
authors.forename: Renaud
authors.initials: R
authors.lastname: Louis
authors.forename: Joachim G
authors.initials: JG
authors.lastname: Aerts
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
authors.forename: Gernot G U
authors.initials: GG
authors.lastname: Rohde
authors.forename: Lucas
authors.initials: L
authors.lastname: Boeck
authors.forename: Janko
authors.initials: J
authors.lastname: Rakic
authors.forename: Andreas
authors.initials: A
authors.lastname: Scherr
authors.forename: Sabine
authors.initials: S
authors.lastname: Hertel
authors.forename: Sven
authors.initials: S
authors.lastname: Giersdorf
authors.forename: Michael
authors.initials: M
authors.lastname: Tamm
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D000402:Airway Obstruction / Q000503:physiopathology; D015415:Biomarkers; D015992:Body Mass Index; D004417:Dyspnea / Q000503:physiopathology; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D011498:Protein Precursors; C088633:proadrenomedullin; D053607:Adrenomedullin